Viral and bacterial infection elicit distinct changes in plasma lipids in febrile children

Abstract

57Fever is the most common reason that children present to Emergency Departments in the 58 UK. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and 59there is no definitive test for the accurate diagnosis of infection. As a result, many children 60 are prescribed antibiotics often unnecessarily, while others with life-threatening bacterial 61infections can remain untreated. The 'omics' approaches to identifying biomarkers from the 62 host-response to bacterial infection are promising. In this study, lipidomic analysis was 63 carried out with plasma samples obtained from febrile children with confirmed bacterial 64 infection (n=20) and confirmed viral infection (n=20). We show for the first time that bacterial 65 and viral infection elicit distinct changes in the host lipidome. Glycerophosphoinositol, 66 sphingomyelin, lysophosphotidylcholine and cholesterol sulfate were increased in the 67 confirmed virus infected group, while fatty acids, glycerophosphocholine, 68 glycerophosphoserine, lactosylceramide and bilirubin were increased in cases with 69 confirmed bacterial infection. A combination of three lipids achieved the area under the 70 receiver operating characteristic (ROC) curve of 0.918 (95% CI 0.835 to 1). This pilot study 71 demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing 72 bacterial from viral infection in febrile children, to facilitate effective clinical management and 73 to the limit inappropriate use of antibiotics. 74